Appendicitis

Austin carawan

Austin carawan

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so if you had a patient with rlq pain and nauseous for 2 days and hasn't eaten much and a slightly distended abdomen the bell would ring, ding ding ding, appendicitis, right? But are there any effective interventions AS A BASIC for this? I obviously can't iv an antibiotic or remove the appendix.....
 
Just because they have a slightly distended abdomen doesn't mean appendicitis, in fact, I would say it would be very unusual. I'd be thinking more along the lines of a bowel obstruction. My physical abdominal exams are not overly detailed; inspect, palpate, auscultate for bowel sounds if I think helpful, maybe percuss (but more than likely not), questioning is a bit more thorough but at the end of the day, if any serious pathology is suspected then CT is going to be the answer so spending ages doing an exam is pointless.

Interventions for abdominal pain? Often the only real intervention in the pre-hospital arena is adequate analgesia. It should be noted entonox is not contraindicated in abdominal pain, it is contraindicated in cases of suspected bowel obstruction. Morphine is also not contraindicated, the old wives tale of it "interferring" with the diagnosis is absolute rubbish. It's more unacceptable to withhold pain relief.
 
Hmm, thank you. I guess I kinda jumped the gun on that one. If bowel obstruction is what you suspect, would you then have a pain similar to appendicitis, or would it be sharp? I imagine rigidity would be palpated with bowel blockage?
 
As you gain experience you will learn that people with the same condition will often present very differently. RLQ pain could be appy, kidney stone, obstruction, UTI, testicular/ovarian torsion, ectopic pregnancy, normal pregnancy, PID, diverticulitis, inflammatory bowel disease, IBS just to name a few.

The description of pain is very subjective. What is sharp to one person is crampy to another. Many people also say their abd is distended when it really isn't. Someone with an obstruction might have some distention and might have rigidity or they might not.
 
Anyone else use the foot strike test to help identify acute visceral pain vs something more generalized like peritonitis/gastroenteritis? It's one of my favorite field diagnostic tricks.
 
wilderness911 said:
Anyone else use the foot strike test to help identify acute visceral pain vs something more generalized like peritonitis/gastroenteritis? It's one of my favorite field diagnostic tricks.
Click to expand...

Psoas?
 
NYBLS said:
Psoas?
Click to expand...

No but that's a good one too. Foot strike test involves giving a sharp rap to the bottom of the patients foot with the leg stretched out in front of them. Ideally they are supine for this. As the force wave travels up through the body it "pings" where it hurts when an organ is involved. It can be reassessed over time in the backcountry or on a long transport and gives an idea of whether the syndrome is progressing or not. Can still be other non-appendix issues of course (I had a girl with ovarian cysts respond positively to the test) but it is, in my experience, a great indicator of whether or not someone needs to get checked out at a hospital or not.
 
Anorexia is an excellent indicator for appendicitis. Distension may be from the associated peritonitis. But, there's about 1834 other things that cause anorexia and peritonitis, so until we get CT scanners and I iSTATs, treat for the worst case scenario-----

..... which is probably the same treatment as everything else in the ddx anyway lol
 
I have done the foot strike (and hand strike) to see where fractures are, and it makes sense for organ pain, but I have never done it for that.
Thank you for the information and learning
 
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